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Improved outcomes after modified Stage-I palliation for hypoplastic left heart syndrome

Omerbasic, Edin LU orcid ; Anvariazar, Shahriar ; Nozohoor, Shahab LU orcid ; Ramgren, Jens Johansson LU ; Johansson, Sune LU ; Odermarsky, Michal LU orcid ; Hallbergson, Anna and Tran, Phan-Kiet LU (2026) In JTCVS Open
Abstract
Objective:
To evaluate short- and long-term outcomes after modified Stage-I (mStage-I) palliation for hypoplastic left heart syndrome (HLHS).
Methods
This retrospective single-centre study analyzed 128 patients with HLHS treated between 1993 and 2023. Patients were divided into two groups: Era-I (n=36), from 1993 to 2001, who underwent the classic Norwood procedure, and Era-II (n=92), from 2002 to 2023, who underwent the mStage-I palliation. Postoperative outcomes, including the need for postoperative extracorporeal membrane oxygenation (ECMO), peritoneal dialysis (PD), recoarctation rate, and overall survival, were compared between eras.
Results
Median follow-up was 9.7 years, with 100% completeness for survival data,... (More)
Objective:
To evaluate short- and long-term outcomes after modified Stage-I (mStage-I) palliation for hypoplastic left heart syndrome (HLHS).
Methods
This retrospective single-centre study analyzed 128 patients with HLHS treated between 1993 and 2023. Patients were divided into two groups: Era-I (n=36), from 1993 to 2001, who underwent the classic Norwood procedure, and Era-II (n=92), from 2002 to 2023, who underwent the mStage-I palliation. Postoperative outcomes, including the need for postoperative extracorporeal membrane oxygenation (ECMO), peritoneal dialysis (PD), recoarctation rate, and overall survival, were compared between eras.
Results
Median follow-up was 9.7 years, with 100% completeness for survival data, and ranged from 0.9 to 30.9 years. Ninety-day survival improved from 69.4% in Era-I to 95.7% in Era-II (P<.001). Transplant-free survival improved from 47% to 84% at 5 years (P<.001) and from 42% to 71% at 20 years (P<.001). Only one patient in Era-II required postoperative ECMO. The use of PD decreased from 86.1% to 22.8%, and recoarctation rate decreased from 13.9% to 7.6%.
Conclusions
On the foundation of important developments in perioperative care across the study period, the introduction of modified Stage-I palliation may have contributed to improved survival and reduced postoperative morbidity, and may represent an alternative to centralization of care. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
JTCVS Open
article number
101918
publisher
Elsevier
ISSN
2666-2736
DOI
10.1016/j.xjon.2026.101918
language
English
LU publication?
yes
additional info
doi: 10.1016/j.xjon.2026.101918
id
4960e588-2ea1-4ccc-884d-431497157d1e
date added to LUP
2026-06-07 13:56:36
date last changed
2026-06-08 07:52:32
@article{4960e588-2ea1-4ccc-884d-431497157d1e,
  abstract     = {{Objective:<br/>To evaluate short- and long-term outcomes after modified Stage-I (mStage-I) palliation for hypoplastic left heart syndrome (HLHS).<br/>Methods<br/>This retrospective single-centre study analyzed 128 patients with HLHS treated between 1993 and 2023. Patients were divided into two groups: Era-I (n=36), from 1993 to 2001, who underwent the classic Norwood procedure, and Era-II (n=92), from 2002 to 2023, who underwent the mStage-I palliation. Postoperative outcomes, including the need for postoperative extracorporeal membrane oxygenation (ECMO), peritoneal dialysis (PD), recoarctation rate, and overall survival, were compared between eras.<br/>Results<br/>Median follow-up was 9.7 years, with 100% completeness for survival data, and ranged from 0.9 to 30.9 years. Ninety-day survival improved from 69.4% in Era-I to 95.7% in Era-II (P&lt;.001). Transplant-free survival improved from 47% to 84% at 5 years (P&lt;.001) and from 42% to 71% at 20 years (P&lt;.001). Only one patient in Era-II required postoperative ECMO. The use of PD decreased from 86.1% to 22.8%, and recoarctation rate decreased from 13.9% to 7.6%.<br/>Conclusions<br/>On the foundation of important developments in perioperative care across the study period, the introduction of modified Stage-I palliation may have contributed to improved survival and reduced postoperative morbidity, and may represent an alternative to centralization of care.}},
  author       = {{Omerbasic, Edin and Anvariazar, Shahriar and Nozohoor, Shahab and Ramgren, Jens Johansson and Johansson, Sune and Odermarsky, Michal and Hallbergson, Anna and Tran, Phan-Kiet}},
  issn         = {{2666-2736}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{Elsevier}},
  series       = {{JTCVS Open}},
  title        = {{Improved outcomes after modified Stage-I palliation for hypoplastic left heart syndrome}},
  url          = {{http://dx.doi.org/10.1016/j.xjon.2026.101918}},
  doi          = {{10.1016/j.xjon.2026.101918}},
  year         = {{2026}},
}